Provider Demographics
NPI:1316959737
Name:BEAZLEY, TED A (DDS)
Entity type:Individual
Prefix:DR
First Name:TED
Middle Name:A
Last Name:BEAZLEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 NORTHCREEK BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-1934
Mailing Address - Country:US
Mailing Address - Phone:615-239-4000
Mailing Address - Fax:615-239-4004
Practice Address - Street 1:318 NORTHCREEK BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-1934
Practice Address - Country:US
Practice Address - Phone:615-239-4000
Practice Address - Fax:615-239-4004
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000046381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice